Fellow Adolescent Medicine/ University of Michigan University of Michigan Ann Arbor, Michigan, United States
Background: The COVID-19 pandemic has been associated with both negative psychological effects and delayed medical care for non-COVID conditions. These factors may worsen outcomes among individuals with eating disorders (ED) and those at risk for these disorders. Emerging data suggest the pandemic has been associated with worsening symptoms of ED among adults. There is a paucity of data on the effects of the pandemic on adolescent ED.
Objective: To determine whether inpatient admission patterns among adolescents with restrictive ED changed since the onset of the COVID-19 pandemic, and to determine whether any observed changes are associated with delays in care or an increase in new cases.
Design/Methods: We performed a retrospective chart review of patients ages 10-23 admitted to a tertiary care children’s hospital for medical complications of restrictive ED from 2017 to 2020, between March 10 and November 30 of each year. Data from 2017-2019 (pre-COVID) were pooled and compared to 2020 (post-COVID). We used χ2, Fisher's Exact, two-sample t-tests, and Kruskal-Wallis tests to determine if patient and disease-course variables differed between groups.
Results: The total number of admissions related to restrictive ED was 61% higher in 2020 (n = 51) than the mean for 2017-2019 (mean = 31.67, Figure 1). Admissions per month were comparable to or lower than pre-COVID rates between March and May 2020, then increased relative to pre-COVID June through November (Figure 2). Admissions among the subset of patients with new diagnoses of ED followed a similar pattern (Figure 3). Patient demographics and markers of disease severity were similar pre- and post-COVID, with the exception that patients admitted in 2020 were significantly more likely than those admitted pre-COVID to have severe (vs mild, moderate, or no) malnutrition (p < 0.001). Median duration of symptoms at the time of admission was similar pre- and post-COVID (8 vs 6 months, p = 0.42); among patients with new diagnoses, median duration of symptoms was 6 months both pre- and post-COVID (p = 0.62). Twenty-two patients admitted in 2020 (43%) reported their ED symptoms began (n = 9) or worsened (n = 13) as a result of the pandemic. Conclusion(s): Medical admissions related to restrictive ED increased among adolescents during the COVID-19 pandemic. Lack of a difference in the duration of symptoms at the time of admission suggest these findings were not due to delays in care and may represent an increase in incident cases.
Authors/Institutions: Jessica M. Jary, University of Michigan, Ann Arbor, Michigan, United States; Julie Sturza, University of Michigan, Ann Arbor, Michigan, United States; Catherine A. Miller, University of Michigan, Ann Arbor, Michigan, United States; Natalie Prohaska, University of Michigan, Ann Arbor, Michigan, United States; Jessica L. Van Huysse, University of Michigan, Ann Arbor, Michigan, United States; Terrill Bravender, University of Michigan, Ann Arbor, Michigan, United States; Alana K. Otto, University of Michigan, Ann Arbor, Michigan, United States
